Abstract 5909: High Plasma Levels of Stromal Cell-derived Factor-1 Alpha Have a Negative Impact on Long-term Prognosis in Patients With Acute Coronary Syndromes
Stromal cell-derived factor-1 alpha (SDF-1α) is expressed in ischemic myocardium and plays a key role in repair of injured myocardium. This study examined whether SDF-1α levels in the circulation may provide a prognostic information in patients with acute coronary syndromes (ACS).
Methods: Plasma levels of SDF-1α from a peripheral vein (PV) on day 3 after onset of ACS were measured using ELISA in 290 consecutive patients with ACS and in 50 age- and sex-matched controls. SDF-1α levels were also measured in plasma from the aorta (AO) and anterior interventricular vein (AIV) in a subgroup of 114 patients with anterior myocardial infarction (MI). After baseline measurements, all ACS patients were prospectively followed for ≤ 60 months or until one of the following cardiac events: cardiac death, nonfatal MI, unstable angina pectoris requiring coronary revascularization, or heart failure requiring hospitalization.
Results: PV levels of SDF-1α were higher in patients with ACS than controls (2476±45 vs. 2212±72 pg/mL, p < 0.01). PV levels were higher in ACS patients with an event (n = 86) than those without an event (n = 204) (2701±82 vs. 2352±54 pg/mL, p < 0.01). In multivariate Cox proportional hazard analysis, higher PV levels of SDF-1α (≥ 2511 pg/mL, defined by ROC analysis) were a significant predictor of an event independently of traditional coronary risk factors (HR 2.1; 95%CI 1.2 – 3.8, p < 0.01). Moreover, there was a significant step-up in SDF-1α levels in the AIV compared with the AO in patients with anterior MI (2690±45 vs. 2501±46 pg/mL, p = 0.02). The AIV - AO difference in SDF-1α levels, reflecting release from ischemic myocardium, correlated positively with PV levels of SDF-1α (r = 0.29, p < 0.01). Both PV levels and the AIV - AO difference of SDF-1α levels had a significant correlation positively with PV levels of brain natriuretic peptide (r = 0.28 and 0.31, both p < 0.01) and inversely with LV ejection fraction (r = − 0.29 and − 0.35, both p < 0.01).
Conclusions: Higher SDF-1α levels in the peripheral circulation independently predict cardiac events in patients with ACS. SDF-1α is released from ischemic myocardium in proportion to the severity of LV dysfunction via a compensatory mechanism and may partly contribute to increased circulating levels of SDF-1á in ACS survivors.